When I passed my MBBS in 1977 and had to decide my specialty and I was convinced that if I want be a good head-and-neck cancer surgeon, I had to be a good ENT surgeon first since head-and-neck oncology will be well learnt that way.

My uncle, a doctor wanted me to either take up obstetrics or pediatrics and I was confused which can be well described by poetry by Robert Frost.

“Two roads diverged in a yellow wood and sorry,

I could not travel both and be one traveller.

Long stood and looked down one as far as I could,

To where it bent in the undergrowth…”

Needless to say I chose ENT to become head-and-neck oncologist to witness the incredible journey of this specialty.

On diagnostic front, fine-needle aspiration cytology (FNAC) was made available in mid 80s and open biopsy became passes. Today, FNAC, for example, in thyroid nodule can categorize the nodule into benign and malignant. In addition, molecular testing and immunohistochemistry are possible on FNAC. FNAC not only reduced invasiveness for diagnosis but also assured the quality of diagnosis.

Ultrasonography also became increasingly useful in differentiating benign from malignant mass and in thyroid in particular can predict malignancy with upward of 95% accuracy. Computed tomography scan and magnetic resonance imaging became available in late 80's and early nineties and remained the choice of investigation for proper assessment of bone and soft tissue, vessels, and lymph nodes.

PET scan arrived in early 20th century and even in developing country like India, its role is paramount in case of unknown primary workup, posttreatment assessment for viable tumor, and thyroglobulin elevated with negative iodine scan syndrome in postthyroidectomy cases.

Availability of Hopkin's telescope, fiberoptic nasopharyngolaryngoscopy and rigid nasal endoscopes have improved the visualization and therefore detecting early cancers. This was the beginning of minimal access surgery in head-and-neck cancer.

Narrowband imaging and contract endoscopy are great addition to these gadgets to detect early cancer.

As far as surgical management in concerned, thyroid surgery is refined to present state where both recurrent laryngeal nerve preservation along with parathyroid preservation with its intact blood supply has become a norm. Minimal access thyroidectomy and robotic thyroidectomy have arrived but, yet to prove their worth in thyroid cancer surgery.

With advent of partial laryngectomy, we were able to preserve laryngeal function in select group of patients who would have otherwise received total laryngectomy. It was soon replaced with transoral laser cordectomy for T1–T2 lesion and chemoradiation for T3 tumors. Voice rehabilitation has also seen its evolution from esophageal speech to mechanical voice of electrolarynx to tracheoesophageal prosthesis. Transoral robotic surgery and transoral endoscopic ultrasonic surgery are the new advances in the surgical management of laryngopharyngeal region, but they are yet to prove its worth.

Radical neck dissection is refined to less morbid modified neck dissection and to even to selective neck dissection after great work done by stalwarts.

Oral cancer management has seen huge advancement from state of second stage reconstruction to pedicled flaps to microvascular flaps. The development of three-dimensional printing and preoperative assessment of reconstruction and developing corresponding prosthesis and implant has already made its mark in the field of rehabilitation.

The harmonic scalpel and ligaSure have really helped surgeons to have bloodless field and also reduce the hospital stay of the patients.

Robotic surgery though in a nascent stage is catching up interest in area hitherto unaccessible to surgeon such as oropharynx and hypopharynx and also where visible scar in the neck is to be avoided as desired by the patient, though proper selection and expertise are of paramount importance in background of high cost.

Learning and teaching saw a new high with online journal, videos, E-books etc., however, it cannot replace learning and training from experienced surgeons. The ease of access to literature and evolution of academic institutions have paved the way for research and innovation.

I have seen the evolution of management of head-and-neck cancer from the flinstonian age to centers with state-of-the-art facility, however, there is still scope for improvement and the beacon which I had carried for years will be carried by the next generation.

I am fortunate to fulfill my dream of becoming head-and-neck surgeon and I can say with Robert Frost

“Two roads diverged in a yellow wood,

And I----

I took the one less travelled by and that has made all the difference.”

“Foundation Oration” given by the editor at FHNO 2017 conference Mumbai.